Individual
MS. TALISHA LADONNA WATTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ANP-BC
Contact information
Practice address
34390 COUNTRY MEADOW RD, CHESTERFIELD, MI 48047-3161
(313) 465-3550
Mailing address
34390 COUNTRY MEADOW RD, CHESTERFIELD, MI 48047-3161
(313) 465-3550
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
2008000145
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1215197082
—
MI
01
—
5008609170
BCBS IND
MI
Enumeration date
06/14/2008
Last updated
05/28/2015
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